Among nucleoside/nucleotide reverse transcriptase inhibitors, tenofovir alafenamide was associated with more weight gain than tenofovir disoproxil fumarate, abacavir, or zidovudine. Among the NNRTIs, rilpivirine was associated with more weight gain than efavirenz. Integrase strand transfer inhibitor use was associated with more weight gain than were protease inhibitors or nonnucleoside reverse transcriptase inhibitors (NNRTIs), with dolutegravir and bictegravir associated with more weight gain than elvitegravir/cobicistat. Pooled analysis revealed baseline demographic factors associated with weight gain including lower CD4 cell count, higher HIV type 1 RNA, no injection drug use, female sex, and black race. Weight gain was greater in more recent trials and with the use of newer ART regimens. We used multivariate modeling to explore relationships between demographic factors, HIV disease characteristics, and ART components and weight change following ART initiation. We performed a pooled analysis of weight gain in 8 randomized controlled clinical trials of treatment-naive people living with human immunodeficiency virus (HIV) initiating ART between 20, comprising >5000 participants and 10 000 person-years of follow-up. We sought to explore factors associated with weight gain in several randomized comparative clinical trials of ART initiation. While some of this weight gain may be an appropriate return-to-health effect, excessive increases in weight may lead to obesity. Initiation of antiretroviral therapy (ART) often leads to weight gain.
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